Surgical versus catheter ablation in atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials
1
Issued Date
2022-10-01
Resource Type
ISSN
10453873
eISSN
15408167
Scopus ID
2-s2.0-85135049786
Pubmed ID
35771487
Journal Title
Journal of Cardiovascular Electrophysiology
Volume
33
Issue
10
Start Page
2152
End Page
2163
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Cardiovascular Electrophysiology Vol.33 No.10 (2022) , 2152-2163
Suggested Citation
Rattanawong P., Kanitsoraphan C., Kewcharoen J., Sriramoju A., Shanbhag A., Ko Ko N.L., Barry T., Vutthikraivit W., Shen W.K. Surgical versus catheter ablation in atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials. Journal of Cardiovascular Electrophysiology Vol.33 No.10 (2022) , 2152-2163. 2163. doi:10.1111/jce.15617 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/85509
Title
Surgical versus catheter ablation in atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials
Other Contributor(s)
Abstract
Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia with a high stroke and mortality rate. The video-assisted thoracoscopic radiofrequency pulmonary vein ablation is a treatment option for patients who fail catheter ablation. Randomized data comparing surgical versus catheter ablation are limited. We performed a meta-analysis of randomized control trials to explore the outcome efficacy between surgical and catheter radiofrequency pulmonary vein ablation in patients with AF. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to December 2020. Included studies were published randomized control trials that compared video-assisted thoracoscopic and catheter radiofrequency pulmonary vein ablation. Data from each study were combined using the fixed-effects, generic inverse variance method of DerSimonian, and Laird to calculate odds ratios and 95% confidence intervals. Results: Six studies from November 2013 to 2020 were included in this meta-analysis involving 511 AF patients (79% paroxysmal) with 263 catheter ablation (mean age 56 ± 3 years) and 248 surgical ablations (mean age 52 ± 4 years). Catheter ablation was associated with increased atrial arrhythmias recurrence when compared to surgical ablation (pooled relative risk = 1.85, 95% confidence interval: 1.44−2.39, p <.001, I2 = 0.0%) but associated with less total major adverse events (pooled relative risk = 0.29, 95% confidence interval: 0.16−0.53, p <.001, I2 = 0.0%). In subgroup analysis, catheter ablation was associated with increased AF recurrence in refractory paroxysmal AF when compared to surgical ablation (pooled relative risk = 2.47, 95% confidence interval: 1.31−4.65, p =.005, I2 = 0.0%) but not in persistent AF (relative risk = 1.09, 95% confidence interval: 0.60−2.0, p =.773). Conclusion: Catheter ablation was associated with higher atrial arrhythmia recurrence when compared with surgical ablation. However, our study suggests that the benefit of surgical ablation in patients with persistent AF is unclear. More studies and alternative ablation strategies investigation in persistent AF are warranted.